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Unanswered: Image to default information into form

Is it possible to take an image that is divided into sections and then click on a certain part of the image and have that information, such as a number, defaulted into a section of a form? I have an image of a county divided into five sections and I want to be able to draw a rectangle around one section and, when it is clicked, it defaults that number into the Location field in the form. Any thoughts? Thanks

Ok, now is there someway to change the Me. part to the name of another form?

EDIT: So I have a form where I type in all the info, then a button on that form that opens another form with an image. I want to put buttons over that image so when I click on the button it auto fills a specific number into a value list box on the first form.